Case Commentary: a Reflection on Ethical Dilemma in End-of-Life Care

Abstract

This case report illustrates the complexity of managing a young patient with complications of diabetes mellitus (DM) and the ethical considerations in decision-making to withhold treatment. Mr. T suffered from poorly controlled type 1 diabetes mellitus with microvascular and macrovascular complications including nephropathy requiring long-term haemodialysis. He was admitted for necrotising suppurative tenosynovitis, which is a type of infection of tendon and synovium, of the right upper limb that led to sepsis and multi-organ dysfunction despite antibiotics and multiple debridements or surgeries. As his condition deteriorated, Mr. T became increasingly confused and uncertain about his goals of care leaving his medical team with difficulty in planning his further treatment. In thinking through the ethical dilemma that arose from this case on end-of-life care, the four-quadrant approach was applied.